What causes diabetic retinopathy?
Diabetic retinopathy is a complication of diabetes in which there are changes in the blood vessels of the retina. The retina deteriorates flowing with oxygen resulting in growth factors being released: a stimulus for the formation of new vessels.
These changes can occur in two forms.
The wall of the small blood vessels changes, thereby the leakage of fluid and blood may occur; this occurs near the yellow spot (macula) and may reduce vision. Which is called diabetic maculopathy.
Similar changes can also arise outside of the area of the yellow spot and do not have any immediate influence on vision; this is called background diabetic retinopathy, however, which can cause a transition under the influence of growth factors in the so-called proliferative retinopathy, in which new blood vessels grow. These new blood vessels are very fragile and can easily cause bleeding in the vitreous inside the eye or seriously damage the retina, resulting in deterioration of the eyesight.
Both forms can occur simultaneously.
The risk of getting retinopathy increases the longer the patient suffers from diabetes.
Because it is possible to suffer from diabetes without noticing anything of it, it is wise to have your eyes checked as soon as diabetes is established. There may be deviations in the eyes, which give complaints or will in the future and must be treated to stop further damage.
During the examination by the ophthalmologist, the pupils are dilated with drops, so that the retina can be viewed properly. These drops make the eyesight temporarily less; therefore you are advised not to drive a car. If any abnormalities are found, it may be necessary to make a scan (OCT) of the retina. With the help of this research, the ophthalmologist can better assess the extent and severity of the defects.
The goal of treatment is to inhibit the retinopathy and so prevent or minimize visual impairment.
With laser treatment, it is possible to aim special light rays on the retina. This will turn off a part of the retina in the treatment so that the demand goes down for oxygen and there are no longer growth factors produced: the (beginning) neovascularization then comes to a stop and / or leakage is decreased. Depending on the nature of the deviations one or more laser treatments are necessary. Because the damage to the retina by diabetes can go on for a long time, additional treatment may be needed later. The preparation for the laser treatment consists of eye drops to dilate the pupil and drops to numb the eye. Depending on the extent of your laser treatment your vision may be limited. Also, the treatment can affect your vision slightly; you should consider this as an investment to prevent later, more serious problems. However with the new green laser this occurs significantly less often, we use only the green laser in these cases.
If there is a lot of leakage particularly centrally, and so a lot of fluid under the retina, it might be necessary to inject anti-inflammatory drugs in the vitreous. (Avastin injection) This causes the fluid to decrease. This is done by a number of monthly injections.
If there is a hemorrhage in the vitreous cavity that does not brighten a vitrectomy may be performed. This is an operation, wherein the vitreous is removed. During the operation, the retina can additionally with laser beams or with cold (cryotherapy) treated.
Unfortunately diabetes gives issues with the sight. Through ever improving research and treatment methods its more and more possible to prevent a retinopathy. In many cases it is possible to prevent blindness. Therefore when you have diabetes you should get your eyes checked regularly in our clinic.
On this website it is summarized what is the result of having diabetic retinopathy and what is possible in order to treat it. Further questions you can ask to our ophthalmologists.